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Phosphodiesterase type 3 inhibitor / antiplatelet Pregnancy: Contraindicated — teratogenic in animal studies.

Cilostazol

Brand names: Pletal

Adult dose

Dose: 100 mg twice daily (30 min before or 2 hours after meals)
Route: Oral
Frequency: Twice daily
Max: 200 mg/day
Intermittent claudication (stable peripheral arterial disease): 100 mg BD for at least 3 months (reassess). Take 30 min before or 2 hours after meals. Reduce to 50 mg BD if co-prescribed with strong CYP3A4 or CYP2C19 inhibitors.

Paediatric dose

Route: Not applicable
Frequency: Not licensed in children
Max: Not applicable
Not licensed in children.

Dose adjustments

Renal

Use with caution in severe renal impairment; not recommended if eGFR <25.

Hepatic

Avoid in moderate-severe hepatic impairment.

Clinical pearls

  • CONTRAINDICATED in heart failure — phosphodiesterase-3 inhibition increases cardiac mortality
  • Significant symptomatic improvement in claudication (increases walking distance)
  • Take on empty stomach or 2 hours after meal — food reduces absorption
  • Reassess at 3 months: continue only if walking distance improved
  • Alternative to naftidrofuryl — both licensed for intermittent claudication

Contraindications

  • Heart failure (any degree — increased mortality risk in HF)
  • Active bleeding
  • Haemostatic disorders
  • Pregnancy and breastfeeding

Side effects

  • Headache (most common)
  • Palpitations and tachycardia
  • Diarrhoea and GI upset
  • Peripheral oedema
  • Dizziness
  • Increased bleeding tendency

Interactions

  • Aspirin and antiplatelet drugs — additive bleeding risk
  • CYP3A4 inhibitors (erythromycin, diltiazem) — increase cilostazol levels (reduce to 50 mg BD)
  • CYP2C19 inhibitors (omeprazole) — increase cilostazol levels
  • Warfarin — not significant but monitor

Monitoring

  • Walking distance (treadmill or 6-min walk test)
  • ECG (arrhythmia)
  • Heart failure signs

Reference: BNFc; BNF; NICE NG19 Peripheral Arterial Disease; EAU PAD Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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